1. CAPA- Choice and Partnership Approach: summary of research and evaluation to 2010
Ann York and Steve Kingsbury

2. How many studies? National (3) 1 UK 2007 1 England 2009
1 New Zealand 2010
Local (16)
CAMHS
2 NZ
1 Australia
13 UK
Adult (1)
1 NZ
Published data: all UK CAMHS
1 national (England)
2 UK New Ways of Working studies
1 redesign report (Richmond)
7 local and 1 national: CAPA book and website
Type of Data
Quantitative e.g waits: 15
User views: 10
Staff views: 12
Referrer views: 3

3. National evaluation: England 2009, Mental Health Foundation
97 teams implementing
Av 6 out of 11 Key Components, range
waits to a first appointment dropped from weeks before to 5-12 weeks after CAPA (N=7)
Families satisfied
Reduced demands on the service
More formalised team working and better planning infrastructure
Greater transparency for staff and families
Few teams were implementing
Job plans (Key component 8)
Full booking systems (K c 5)
Handling demand ( K c 3)
Recommendations: including
CAPA should be rolled out gradually, for teams to opt-in
A national support framework for CAPA should be established

4. National Survey , 2007 Steve Kinsgbury & Ann York
Online survey
40 teams out of 113 were using CAPA
On average CAPA in place 8 months
Waits:
CAPA teams
Before CAPA: average 20 weeks
After CAPA: 73% had waits to Choice of 6 weeks or less
Non- CAPA teams
Wait to first appointment on average 12 weeks. Only 33% had waits of 6 weeks or less
CAPA compliance on items 2-11:
CAPA teams 7.1
Non-CAPA: 2.5

5. National evaluation NZ 2010
Awaiting data analysis Oct 2010!
Evaluation data collection complete.

6. Local studies (16 CAMHS & 1 GAMHS)
International:
CAMHS
2 NZ - Capital Coast; Christchurch
1 Australia- Kirwan
Adult
1 NZ GAMHS- Wellington
UK (13 CAMHS):
Sheffield
Somerset
Lincs
Bristol
Exeter
Gloucs
Stockton (NWW)
Stockport
Glasgow
East Herts (staff)
E Herts (users)
Richmond (NWW)
Richmond (service)

7. User views 2 NZ 8 UK Mix of direct interviews and questionnaires
Overwhelming majority extremely positive:
Seen quickly
Felt listened to
Got new ideas

8. Staff views Data 1 NZ 9 UK Results Increased job satisfaction
Increased morale
Anxiety about change
Improved team working
More focussed
Love team discussion
Increased learning

9. Quantitative impacts Data: 1 NZ 8 UK Waits
Pre CAPA: range from 5- 9 months
Post CAPA: range from 1-6 weeks
Transfer to Partnership
range %
Waits to Partnership
4 weeks (some teams developed longer waits due to not implementing full booking)
DNAs:
5- 10 %

10. Adult Mental Health Data 1 NZ (4 GAMHS) Waits Pre CAPA: 35 days
Post CAPA: 20 days
DNAs
Pre CAPA: 3%
Post CAPA: 2.8%
Activity
12% increase in referrals
11% increase number offered appt
11% increase in patients seen

11. CAPA Implementation in England Mental Health Foundation 2009
NATIONAL
CAPA Implementation in England
Mental Health Foundation 2009

12. Phase 1 Phase 1 was a national survey of CAMHS in England
123 staff from 442 teams answered a questionnaire
97 teams stated they were implementing CAPA
53 of these 97 teams completed a more detailed survey:
on average, were implementing 6 out of the 11 CAPA key components (range 1 to 10.5).
7 teams supplied audit data pre and post CAPA implementation:
waits to a first appointment dropped from weeks before implementation to 5-12 weeks after

13. Phase 2 Phase 2 involved visits to six CAPA teams
Benefits reported were:
Reduced waiting times
92% of families were seen within 13 weeks compared with the national average of 78%.
Families were pleasantly surprised at how quick they could get into the service
Reduced demands on the service
More formalised team working and better planning infrastructure
Greater transparency for staff and families

14. Challenges
Few teams were implementing
Job plans (Key component 8)
Full booking systems (K c 5)
Handling demand ( K c 3)
Result was waits to Partnership.
Teams felt the need for more information and support in how to apply CAPA to complex and long term cases.

15. National recommendations
1.         CAPA should be rolled out gradually, for teams to opt-in
2.        A national support framework for CAPA should be established
3.        An enhanced training package should be available
4.        A national online network and directory of CAPA implementers could be developed
5.        The CAPA implementation training and support package needs to address the commonly held CAPA Myths
6.       Case studies to illustrate how the system can work in different types of services

16. Local Implementer recommendations
1.         Facilitative team management is crucial- an informed manager, a clinical lead, and an administrative lead (CAPA Key Component 1)
2.        CAMHS teams implementing CAPA need mechanisms to facilitate effective team working: peer group supervision and regular away days (CAPA Key Components 10 and 11)
3.        Children’s Trust directories should be used to promote multi-agency work or to signpost families
4.        Successful implementation of CAPA should involve staff from a variety of roles within the CAMHS
5.        Monitoring and feedback are integral prior to, during, and after the implementation phase
6.       Local regional support systems should appoint a number of local CAPA champions

17. Survey of CAPA implementation 2007
Kingsbury & York, 2007

18. Method
November 2007
we contacted services known to us and put a request out on an international discussion forum (FOCUS Mailbase; through an online questionnaire
We asked for general information about their services, whether or not they had implemented CAPA and the impact
We asked for ratings on items 2 to 11 of the 11 Key Components of CAPA i.e. omitted Item 1: Management and Leadership (we hadn’t highlighted this item then)

19. Results 40 out of 113 people had implemented CAPA
On average, CAPA had been in place for 8 months
Teams received on average 47 referrals per FTE per year: 50% were in the range 57 to 33 FTE
Waits:
CAPA teams
Before CAPA: average 20 weeks
After CAPA: 73% had waits to Choice of 6 weeks or less
Non- CAPA teams
Wait to first appointment on average 12 weeks. Only 33% had waits of 6 weeks or less

20. Compliance with Key Components

21. NZ National Evaluation 2010
Werry Centre

22. pending

23. Local Implementation
References available from Ann

24. Green Team, Canterbury DHB NZ Karina Falconer-Beach 2008
National innovation Award report:
TRIALLING THE CHOICE AND PARTNERSHIP APPROACH: RIGHT TIME, RIGHT INTERVENTION WITH THE RIGHT PEOPLE
Method:
Dec 2007 to April 2008
Compared CAPA in Green Team to 2 pre CAPA cohorts in previous 2 yrs
8 month development phase
Skills mapping
2007/08 CAPA gp: 51 families (52 children)
5-12 yrs
2006/07 Pre CAPA gp 1: 33 families
2005/06 Per CAPA gp 2; 33 families
2-12 yrs

25. Green Team (2) Quantitative 750 refs pa, accept 450 5.5.FTE Waits:
Waits:
Pre CAPA: 6-9 mths
12 mth internal waits.
Post CAPA:
 Lower first appt DNA rate in CAPA gp
 Transfer to Part: 90% with 13.4% DNA
 Time to discharge:
At 6 mths over 50% CAPA gp closed cf 32% gp 1 and 23% gp 2
 Co-work rate CAPA: 84%

26. Green Team (3) User experience
Goals set:
CAPA gp: 82%
Gp 1 and 2: 0
Family friendly letters:
CAPA: 98%
Gp 1 and 2; 0% or no letter at all
Satisfaction:
Choice Que:
High satisfaction
Independent Phone call:
9/10 happy
No formal complaints (usually 2-3)
CAPA: reduction in CBCL scores post treatment

27. Green Team (4) staff experiences
Choice done by experienced staff
Work satisfaction Que:
CAPA staff reported more satisfied, felt more valued and enjoyed work more than non CAPA staff
Attitude to families shifted to more collaborative
Easier to ‘let go’ of families with CAPA
Felt like a burden been lifted.

28. Green Team (5) other CAPA-CRS: 86% full implementation
GPs and referers: post discharge- positive

29. Lincolnshire Stephanie Stockbridge, Anne Thompson, 2007
7 mths preparation
Started Feb 2007
15 FTE
20 refs pw
Waiting list of 77- blitz
Daily ref screening
Results
Waits:
Pre CAPA: 25 wks
Post: 6 wks
 Trans to Partnership rate: 80%
 Co-therapy rate: 57%
100% staff satisfied with offering Choice
CAPA-CRS: 66 % compliance at 6 months

30. Bridgeton, Glasgow Wendy Jenkin, 2006
Implementation in Under 12s service
 SDQ
CHI ESQ
Clinician Que
Results
Waits
Pre CAPA: 9 mths
Post: a few weeks
 DNA 6%
User feedback:
N=28 (response rate 34%)
Majority very satisfied

31. Bridgeton (2) Staff views: N=7: Initial anxiety Use clearer language
Focussed
Sense of partnership with families
Clarity
More relaxed
More systematic
Less stress in team
GP/referrer feedback:
N=52
Good service
Feedback reports rather long but clear

32. Sheffield Nevyne Chaloub, 2009
CAPA 1 year on data: 3 teams
Quantitative data plus staff views 6 months in. 25 matched pairs pre and post CAPA
% Redirected at referral reduced from around 25% to 8-16%
Increase in referrals from around 400 (accepted 350 to 400 to460)
Waits:
Pre:
Post: 7-9 wks
Choice to Partnership wait:
6-8 wks
C/P trans rate: 72-62%
DNA: 9-12%
New: FU ratio
Choice Plus: 2%

33. Clincians views One team less positive than the other 2.
 Felt imposed by management, rigid and hindered creativity
Did NOT think:
Added quality (less joint assessment)
Workload could be sustained
Mixed views on whether
Was efficient
My job plan is working
Agreed
Opportunities for discussion
Compared to pre CAPA:
More shared understanding
1 team-Increased job satisfaction and morale (tho some felt worse); other 2 mixed

34. Admin staff Negatives: Duplication in processes Ideas to improve
2009
Positives:
Prefer CAPA to old system
Clincians now ask them to do more
Felt well prepared for CAPA
Tracking clients easier
Easier to do Partnership admin
More efficient than old system
Higher workload
Mixed views:
re Choice admin
2010- all above areas more highly positive
Negatives:
Duplication in processes
Ideas to improve
Reduce time spent chasing clincians for slots
Merge systems

35. User experience
References available from Ann

36. Youth views on CAPA Bridget Greaney, Capital & Coast, NZ 2009
Youth views on CAPA- focus gp after presentation on CAPA
 Views of Youth Consumers Advisors
 User views
Results:
Youth Focus gp
Like:
Talk re goals not just problems
Match clinician to their needs
Don’t have to see Choice clinician again if not like them
The name ‘Choice’
Dislike:
Choice if really sick, may say no
Word ‘Partnership’ not mean anything

37. Youth views (2) Advisor gp: Reduced waits Choice of appts
Clear pathway for users
User views:
12-19 yrs
N= 53
66% found Choice useful
83% given enough info
100% felt taken seriously

38. Audit of 100 families. Steve Kingsbury 2006
Tracking of the first 100 CAPA families in East Herts CAMHS:
CHI-ESQ
CAPA Experience Que
Results
Highly positive on all measures

39. User and Carer involvement in Service redesign: New Ways of Working national pilot. Ann York 2007
Que and direct interviews with children, young people and families
CHI ESQ:
Children n=7
Young people n=27
Parents/carers n= 35
Direct interviews:
Children < 11 y n= 3
Young people n = 11
Parents/carers n= 34

40. Exeter: Vikki Barnes, 2009
Ques to Parents who had recently attended a Choice appt.
Response rate: 42%
CAPA Experience Que
CHI-ESQ
Waits:
Pre CAPA: 6 mths
Post: 2-4 wks
User views:
Choice appt was useful
CHI ESQ positive

41. User & Carer involvement (2)
Children, young people and parents/cares all very positive at interview and on CHI ESQ
Que feedback from GPs- positive
Full report is 200 pages long

42. Gloucester CAMHS Anna Burhouse, 2006
9 mths planning
Started July 2006
6 FTE
338 referrals, accepted 267 (5 pw)
WL Blitz: 39 families, took 1 mth

43. Gloucs (2) Results CAPA-CRS: 97% Waits: Post: 3-4 wks
4 wks to Partnership
User feedback:
100% positive
Staff feedback:
Very positive
Higher job satisfaction

44. Richmond CAMHS Mona Botros & Ann York 2009
Method
Sept 2008 to Feb 2009: user feedback questionnaires on Choice
1-5 Likert scale
Results
N= 43
Response rate 25%
93% found Choice helpful or extremely helpful
100% felt listened to
53% got new ideas
88% given enough info
 23% felt seen too quickly
44% felt seen very quickly
5 % felt waited too long
Free comments: 8 positive, 1 negative (parent demanding meds that were refused)

45. Richmond CAMHS (2) Hannah Thorpe Vanishri Yadav, 2010
Method: March Feb 2010 Choice feedback forms completed by users Results: N=132 On Likert scale 1 to 5, scores of 4 and 5: 84% found the Choice appointment helpful/extremely helpful; 96% felt listened to 57% felt got new ideas 86% got enough info on the service 14% felt seen too quickly 39% felt wait was fine (waits were 4 weeks). Rest scored 3,2 or 1 (45% in total, mainly scores of 3)

46. Staff experience
References available from Ann

47. Staff views on implementation Kingsbury & York 2006
Method
Focus group of clincians, transcribed by assistant psychologist and analysed by Steve and Ann
Results
Before started: worry re
May not work
Adapting to new way of working
What helped:
Vision
Leadership
Commitment
Planning
What think like for families?
Focus on what they want
Easier to ensure CAMHS right service

48. Staff views (2) How change practice? More focussed Think more clearly
More collaborative
Shared language
Problems:
Sense of missing something if not done Choice
What helped transfer?
Clear formulation
Right skills
Iterative process
Flexibility re co-working

49. Staff views (3) Liked: Pride in no waiting list Referrers pleased
How to make it work well:
Monitoring processes
Formulation with family
Team discussion
Trust in team
Other tips
Get resource file
Adapt it

50. Staff views Caroline Fell Southmead CAMHS, Bristol, 2009
Method
3month collection period
Que to all Choice clinicians
n= 17
Results
Majority of users waited 1 to 4 weeks for Partnership
Majority of staff felt:
Intervention been discussed at Choice
Matching of skills/personality

51. N Somerset CAMHS Emma Stapley, 2007
Narrative of implementation experience- semi structured interviews with clinicians
4.7 FTE
Received 342 refs, Accepted 307
 5% DNA Choice
Transfer to Partnership rate: 70%
Staff views:
All positive
Felt user friendly service
Value team working
More focussed
Challenges:
Not enough Partnerships
Pressure to discharge
Managing variation in demand
Bottlenecks to some specialists

52. Stockton CAMHS Tracey Splevins and Roger Williams, 2007
New Ways of Working national project
28 FTE
750 refs pa (14 pw)
Staff ques and semi structured interviews
Results:
70% of users seen within 4 weeks
CAPA –CRS: 86% full compliance
Some staff felt threatened and suspicious that would cut costs and erode professional expertise
 Clear mechanisms to collect data
 Skills valued and respected
 Morale improved
 Team functioning improved
newwaysofworkinghttp://

53. Stockport CAMHS, 2008 27 FTE Planning took 5 mths Care Bundles
Specific clinics
Sought staff experiences
Waits:
Pre CAPA: 28 wks
Post: 5 wks
CAPA-CRS: 97%
Staff:
Like Choice
Streamlined paperwork
Partnership working enhanced

54. Adult Mental Health
References available from Ann

55. Adult Mental Health, NZ Tony Littlejohns, Capital & Coast 2009
Service audit of CAPA implementation in 4 GAMHS Mar- Oct 2009:
Introduced:
Single point of entry
Fully booked Choice appts
Results
Waits to Choice-
Per CAPA 58 days
Post: 30
DNA; approx
Pre: 3%
Post 2.8%
11% increase in refs
16% increase in pts seen